Case 2
An 81-year-old woman was diagnosed with RA at the age of 27 years. She was treated with methotrexate (6 mg/week) and prednisolone (4 mg/day). She had been treated with denosumab (60 mg/6 months) and vitamin D for osteoporosis (the bone mineral density T-score of the left hip was -2.8). She had previously undergone partial talectomy (only the protruded region) 8 years prior for recurrent skin infection of the contact region with floor in her left foot. During this surgery, a bony protrusion of the talus caused by a calcaneovalgus abnormality was removed. Callosity was detected in her left foot, and a severe calcaneovalgus deformity remained (Figure 4 A, B). The patient presented to our hospital complaining of gait and weight-bearing pain in her left ankle joint. The radiographic findings in the patient’s left ankle joint was Larsen Grade IV in both the talocrural and subtalar joints (Figure 5 A, B), and we decided to perform ankle arthrodesis to correct the deformity and improve the functional outcome.
We used the same surgical approach and grafting procedure (Figure 6 A, B) for this patient as those described in Case 1. The finned intramedullary retrograde ankle nail was inserted from the plantar side. Postoperative care was the same as in Case 1. Macroscopic findings showed correction of ankle alignment and no skin issues 1 year postoperatively (Figure 7 A−C).